Discoid lateral menisci in older patients

Abstract

Twenty-three knees of 21 patients over 40 years of age with discoid lateral menisci were examined by radiography. The mean age of the patients was 59.7 years (range: 40-78 years). No patient had symptoms before the age of 40 and only 12 knees gave symptoms from the lateral compartment, although tears of a discoid lateral meniscus were diagnosed by arthrography in 21 of the 23 knees. Varus inclination occurred more frequently than valgus inclination. Subchondral bone sclerosis was more common in the medial compartment. However, high incidences of marginal osteophytes in the lateral compartment and morphological anomalies (cupping or flattening) of the lateral tibial plateau were revealed by radiography.Résumé Vingt-trois genoux de 21 patients âgés de plus de 40 ans avec des ménisques latéraux discoïdes furent examinés par radiographie. L' âge moyen des patients était de 59.7 ans (40-78 ans). Aucun des patients ne montra de symptômes avant l' âge de 40 ans et seulement 12 genoux devinrent symptomatiques dans le compartiment latéral, bien qu'un déchirement du ménisque latéral discoïde fut remarqué par arthrographie sur 21 des 23 genoux. Un varus fut observée plus fréquemment qu'un valgus. Une ostéosclérose sous-chondrale fut remarquée plus souvent dans le compartiment médial. D'autre part, des incidences élevées d'ostéophytes marginales dans le compartiment latéral ainsi que des anomalies morphologiques (bombement ou aplatissement) du le plateau tibial latéral furent aussi signalées par radiographie. IntroductionDiscoid lateral menisci are commonly thought to give symptoms at relatively young ages [4,8,11] and their radiographic characteristics, such as widening of the lateral tibiofemoral joint space and cupping of the lateral tibial plateau, have been described previously [1][2][3]. However, some studies have reported patients who neither had symptoms nor became symptomatic until middle age [1,2]. Only scarce information is available regarding discoid lateral menisci in these patients. We therefore assessed clinical and radiographic characteristics of the discoid lateral meniscus in patients over 40 years of age. Patients and methodsBetween 1991 and 1994 we studied 21 patients (23 knees) who developed knee symptoms after 40 years of age and in whom arthrography revealed a discoid lateral meniscus. The average age was 59 years and our findings are summarised in Table 1. The clinical and radiographical findings in these patients were retrospectively assessed by 2 independent observers who had no knowledge of the patients' clinical course. The average interval between the onset of symptoms and the radiographic examination was 4 weeks (range: 0-12 weeks).The presence of osteophytes and subchondral bone sclerosis, together with the morphology of the lateral tibial plateau, were demonstrated by anteroposterior and lateral radiography of the knee in the supine position. The presence or absence of flattening or of cupping of the lateral tibial plateau was noted. If the distance between the deepest part of the co...

Do Age and Weightbearing Radiographs Affect Lateral Joint Space and Fibular Height Measurements in Patients With Discoid Lateral Meniscus?

“…In contrast, many studies have been published describing characteristic radiographic findings associated with a discoid lateral meniscus. 8,13,19,21 In 1950, Jeannopoulos 10 reported 21 cases of discoid lateral meniscus. Of these 21 cases, 4 exhibited a widened lateral joint space and 2 demonstrated lateral femoral condyle hypoplasia on radiographs.…”

“…Since most of the literature describing radiographic changes associated with discoid menisci has been in adults, it is not known whether these radiographic changes are present in youth or develop over time. In a study of 23 adult patients with discoid menisci, Nawata et al 19 hypothesized that characteristic radiographic changes may be induced by the abnormal morphologic features of the lateral discoid meniscus causing a mechanical imbalance between the medial and lateral compartments of the knee with aging. While our overall results showed that both LJSW and FHH were significantly different between pediatric discoid and control patients, our subgroup analysis based on age showed that FHH was significantly decreased (indicative of a high fibular head) in the discoid group across all ages, while increased LJSW was significantly different only in patients older than 14 years.…”

Short-Term Effects of Discoid Lateral Meniscectomy on the Axial Alignment of the Lower Limb in Adolescents

“…In our study, the preoperative varus angle of adolescent patients with a torn discoid lateral meniscus was significantly greater than that of adolescents with a torn or intact nondiscoid lateral meniscus. Previous reports have indicated that the existence of a discoid lateral meniscus altered the distribution of contact stress in the knee and accelerated the degeneration of the medial joint cartilage 18,19 . Therefore, the treatment of a symptomatic discoid lateral meniscus is important.…”

The adaptive change of patellofemoral joint after arthroscopic discoid lateral meniscus plasty

“…Moreover, the lateral compartment was covered with DLM which affected the contact pressure, also could cause the mechanical balance different from that in knee joints with a semilunar-shaped lateral meniscus. Nawata et al [ 17 ] reported that subchondral bone sclerosis or osteoarthritic changes can occur more frequent on the medial compartment in patients with DLM. The possible reason was that the tendency toward varus alignment with DLM could increase the contact pressure on the medial compartment.…”